Tranexamic acid is effective for blood management in open-wedge high tibial osteotomy

Abstract

Introduction: There has been paucity in literature regarding the blood-sparing effect of TXA after high tibial osteotomy (HTO). The purpose of this study is to determine the efficacy of tranexamic acid (TXA) with regard to its blood-sparing effects in open-wedge HTO, and to assess thromboembolic complications in patients undergoing open-wedge HTO with or without the use of TXA.

Hypothesis: The intravenous TXA would reduce postoperative blood loss and transfusion requirements without increasing thromboembolic complications in open-wedge HTO.

Materials and methods: From March 2011 to December 2016, medial open-wedge HTO was performed in 150 consecutive knees with varus gonarthrosis. The mean age at the time of surgery was 55.3±5.0 years. TXA was intravenously used in the latter 75 knees (TXA group), and the group was retrospectively compared with the former 75 knees without use of TXA (control group). Outcome measures were postoperative hemoglobin drop, drain amount, total estimated blood loss, transfusion requirements, and incidence of thromboembolic complications.

Results: The use of TXA led to a significant decrease in hemoglobin drop (p<0.001) and drain amount (p=0.025). Total estimated blood loss was lower in the TXA group than in the control group (p<0.001). Two knees in the control group had postoperative blood transfusion, compared to none in the TXA group (p>0.05). There were no thromboembolic complications such as symptomatic deep vein thrombosis and pulmonary embolism in both groups.

Conclusion: The use of TXA reduced perioperative hemoglobin drop, drain amount, and total estimated blood loss without thromboembolic complications in patients undergoing open-wedge HTO. Therefore, the use of TXA is a safe and viable option for perioperative blood management in open-wedge HTO.

Level of evidence: III, Case control study.

Keywords: Blood loss; Blood management; High tibial osteotomy; Knee; Tranexamic acid.

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